Haemophilus influenzae sepsis and placental abruption in an unvaccinated immigrant

• Authors: Paula A. Calner, Boston Medical Center; Megan L Salinas, Boston Medical Center; Alaina Steck, Emory University; Elissa Schechter-Perkins, Boston University
• Journal Title: Western Journal of Emergency Medicine
• Volume: Volume 13, Number 1
• Publisher: UC Irvine Health School of Medicine. | 2012-02-01, Pages 133-135
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.5811/westjem.2011.7.6783
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology; Health Sciences, Immunology

Abstract

Background: Haemophilus influenzae infections have declined dramatically in the United States since implementation of the conjugate vaccine. However, in countries where widespread immunization is not routine, H influenzae remains a significant cause of morbidity and mortality. We report a case of a previously unvaccinated immigrant with confirmed H influenzae sepsis and placental abruption leading to spontaneous abortion. Objectives: To alert emergency medicine practitioners that H influenzae should be recognized as a maternal, fetal, and neonatal pathogen.Clinicians should consider this diagnosis in immigrants presenting with uncertain vaccination history, as H influenzae can cause significant morbidity and mortality. Case Presentation: A 36-year-old female was referred to our emergency department (ED) with lower abdominal pain with some vaginal spotting. The patient had an initial visit with normal laboratory investigations and normal imaging results, with complete resolution of symptoms. The patient returned to the ED with sudden onset of vaginal bleeding and abdominal pain. She presented at this time with sepsis, which progressed to septic shock, causing placental abruption and ultimately, spontaneous abortion. The patient was treated with pressors and antibiotics and was admitted to the medical intensive care unit where she received ampicillin, gentamycin, and clindamycin for suspected chorioamnionitis. The patient's blood cultures came back positive after 1 day for H influenzae. The patient did well and was discharged from the hospital 4 days later. Conclusion: Haemophilus influenzae should be recognized as a neonatal and maternal pathogen. Clinicians should consider this diagnosis in immigrants presenting with uncertain vaccination history, especially in pregnant females, as H influenzae can cause significant morbidity and mortality.